Priorities for Strategy 4.3
Updated: January 2019
Develop innovative service delivery models to improve dramatically the outcomes of mental health services received in diverse communities and populations
Service delivery systems have evolved over time to provide care to children and adolescents with developmental precursors of mental illnesses and people with mental illnesses through a wide variety of structures and processes. Based on available data, NIMH recognizes that current models are inadequate to meet the mental health service needs around the globe. New opportunities to significantly improve impact on population health may be offered by service delivery models that move beyond limitations imposed in the current system. NIMH encourages proposals to develop and test innovative and sustainable models of care that eliminate traditional shortcomings of mental health care provided in various sectors and use developmentally and culturally sensitive and advanced tools to better reach populations in need and deliver appropriate and progressively improving care.
- Develop systems-level strategies in non-traditional mental health settings, using technology and other approaches, to identify, support, and monitor the effectiveness of care for individuals with mental illnesses.
Priority areas include:
- Capitalizing on innovations in technology, consistent with the NAMHC workgroup on technology report, Opportunities and Challenges of Developing Information Technologies on Behavioral and Social Science Clinical Research, to improve early detection of mental illnesses connect patients across all ages to evidence-based care, increase reach of, and engagement with, services for underserved populations, to ultimately improve key outcomes.
- Developing and testing strategies to make evidence-based practices available, deliverable, effective, and scalable in non-specialty settings where significant unmet need exists. These settings may include criminal justice; military or veteran organizations; colleges or other academic settings; the child welfare system; and, geriatric service settings.
- Developing novel service delivery models, which capitalize on unique features of various service settings (e.g., social settings that foster connection with the target population, schools, social services, or other community-based settings, and online/virtual communities), including strategies for outreach, engagement, retention in and adherence to treatment/services, which may have a bidirectional interface with more traditional care settings.
- Develop and validate service delivery models that provide responsive and pre-emptive evidence-based supports for individuals throughout the course of illness.
Priority areas include:
- Applying new methods to understand care pathways and identify mutable emerging barriers and facilitators to improving access and continuity of care, and developing and testing system-level interventions to improve best practices and outcomes in new and understudied populations across the developmental lifespan (e.g., children and adults with, or who are at risk for, autism).
- Developing and testing the effectiveness and implementation of care coordination strategies (e.g., case management, family navigator models, coordinated specialty care) designed to promote early identification, early access, engagement, continuity, and coordination of mental health treatment and services for children and adolescents who are experiencing early symptoms of mental health problems.
- Defining and testing the specific targets and mechanism(s) of action purported to improve mental health outcomes in service delivery. Task shifting is one of several mechanisms to be studied. When paraprofessionals or peer providers are involved in service delivery, the research should make clear the intended purpose for involving nontraditional staff (e.g., addressing work force shortages, instilling hope and remoralization, improving client engagement) and then test whether target engagement mediates outcomes, with consideration for scalability of strategies that prove effective.
- Studying national, state, provincial, and local level approaches to find efficient and effective solutions to improve access to, and value of, mental health services.
- Develop and validate coordinated medical decision-making models that bridge multiple social and medical care settings to integrate the appropriate care for people with serious mental illnesses and multiple chronic conditions.
Priority areas include:
- Studying service delivery models that integrate treatment for mental illnesses within primary medical care, including care decision models for treating mental illnesses and multiple chronic medical conditions.
- Developing and validating tools to assess mental health needs and mental health service capacity in non-specialty settings where children and adolescents are served (e.g., pediatric primary care, schools); developing and testing decision support tools to facilitate the identification and adoption of evidence-based interventions and services that are matched to need and capacity.
- Using technologies (e.g., mobile devices, information systems) to significantly improve access to, reach of, engagement in, and efficiency and quality of integrated mental health services across settings.
- Investigating strategies for active symptom management that reduce the symptom burden in patients with serious mental illnesses and multiple chronic conditions.